5.0 POLICY CORE SPECIFIC AIMS Despite many years of prevention interventions targeted at individuals, HIV infections continue to occur at an alarming rate. Increasing attention is thus being directed by the research and policy communities to structural-level interventions, recognizing that prevention efforts must not only target individuals and their behaviors, but also focus on the public-sector and private-sector policies that set the context within which HIV prevention, identification and treatment occur. The goal of the Policy Core is to stimulate research to examine both public and private policies, in order to identify the obstacles and leverage points that they may present to the promotion of HIV detection, prevention and treatment at national, state and local levels, as well as internationally. The Core's purview includes data analyses and identification of each link in the policy-making chain that is a potential barrier to or facilitator of science-based action: for example, we examined variations in the uptake of male circumcision depending on a state's insurance coverage for the procedure. If the impacts of the policies are not identified and analyzed, health benefits cannot be realized. The Policy Core strives to disseminate the resulting findings from its analyses to public health and government leaders and the public, so that they have the evidence base necessary for well-informed policy making. The goal of the Policy Core is to bridge the gap between research and policy to make more effective the fight against HIV in the U.S. and abroad. The National HIV/AIDS Strategy For The United States stated that one missing element in prior efforts to combat HIV is community-level approaches to altering the conditions in which HIV is transmitted and addressing the factors that influence disparate health outcomes among people living with HIV....[1] Public and private policies can promote or stand in the way of implementing community-level initiatives that clinical or behavioral research shows to be efficacious. For example, clinical research and computer modeling strongly suggest that initiating earlier ARV treatment to lower an individual's viral load, and thereby reduce overall community viral load, would lessen the transmission of HIV in a community.^ However, implementing this Testing & Linkage to Care Plus Treatment (TLC+) approach is hampered by policies of both private and public insurers, who will pay only for services that the Preventive Services Task Force (PSTF) recommends be routinely offered. Despite the Centers for Disease Prevention and Control (CDC)'s recommendations for routine HIV screening in medical settings,[3] the PSTF guidelines endorse only risk-based testing, enabling insurers to decline payment for routine screening, which is an integral component of TLC+. Objective, credible, and unbiased analysis of the cost-effectiveness of the TLC+ approach and dissemination of this information to policy makers in readily accessible formats, such as Policy Briefs and through legislative testimony, could help to remove the barriers to broadly implementing efficacious clinical research findings. Therefore, the Policy Core has three specific aims: 1. Science: Promoting research that increases understanding of how local, state, and national policies create incentives that increase or inhibit identification, prevention, and treatment of HIV disease; fostering research to understand how scientific evidence influences policies. The Core focuses on three areas that have particularly significant impact on these issues: the rapidly evolving development of biomedical interventions, the profound change in the policy context anticipated with the implementation of the 2010 Affordable Care Act, and how the implementation of new technologies impacts health disparities. 2. Networking: Convening policy makers, HIV investigators, and community stakeholders; participating in national, state and local task forces; and providing scientific evidence for policy making. The Core disseminates, in various formats, policy-relevant findings from intervention and policy research to domestic and international audiences, with the goal of providing unbiased evidence for policy making, as opposed to advocacy for a predetermined position. The Core convenes policy makers, HIV investigators, and community stakeholders to identify and address critical HIV policy issues and its researchers participate in national and international task groups advising on HIV policy. 3. Capacity Building: Enhancing the skills of our research partners to apply policy-analytic methods (e.g., cost-effectiveness analysis (CEA) and geographic information systems methods (GIS)) to their HIV projects and increasing their ability to evaluate their prevention programs. Table 5.1: Policy Core Primary Functions 1. Promote research to evaluate how public and private policies impede or promote HIV prevention, detection, treatment. 2. Convene policy makers, community stakeholders and researchers to identify and address critical HIV policy issues. 3. Capacity building for research and community partners, particularly for evaluation.